DEPARTMENT OF BIOMEDICAL ENGINEERING FACULTY OF ENGINEERING UNIVERSITY MALAYA

Lab 5 : HEARTS SOUNDS, PULSE RATE AND BLOOD PRESSURE

Objective
In this experiment, the main objective is to describe some of the techniques used in the assessment of the cardiovascular system. For example auscultation of normal heart sounds and measurement of blood pressure are the two methods which can be used in the assessment of the cardiovascular system.

Introduction
Sounds of heart can be hear through stethoscope, thus it can used for the assessment of the auscultation. There are 2 main components that build up a stethoscope, which are diaphragm and bell. The diaphragm is used to hear sounds with high pitch whereas the bell is used to hear low-pitched sounds. The pulse rate of a person can be determined through the radial pulse. The normal pulse rate of a person is around 60-100 per minutes. The blood pressure can be measured with the help of mercury sphygmomanometer. The normal blood pressure of a normal person is 120/80mmHg. 120mmHg is refer to systolic blood pressure while 80 mmHg is refer to the diastolic blood pressure.

Apparatus
1. Mercury sphygmomanometer 2. Digital stopwatch 3. Stethoscope Deluxe

Procedure
(a) Heart Sounds 1. For this procedure, students are encouraged to work in a pairs. 2. By using a stethoscope, heart sound of a subject can be heard by placing the diaphragm on the areas on auscultation. 3. The 1st heart sound (S1) and the 2nd heart sound (S2) can be heard. Their qualities are being compared and recorded in the result sheet. 4. During the process f auscultation, we can try to listen to the 3rd heart sound (S3) which sometime it can be heard from normal people. (b) Arterial Pulses 1. The subject must be in sitting position for at least 5 minutes before advance to the step 2 in this part. 2. Radial pulse of the subject is being palpated at the wrist and counted for one minute. The number of pulses per minute is recorded in the result sheet. 3. After that, the subject is asked to stand up straight. The pulse of the subject is immediately count again for one minute. The subject must be in up-straight standing position during the counting process.

4. The pulse rate of the subject when sitting and standing are being compared. Any differences are recorded into the result sheet for further comparison. 5. The subject later is asked to do some simple exercise for example running up and down staircase. Subject need to do the exercise for about 2-3 minutes. After doing the exercise, pulse rate of the subject are counted immediately. The results are recorded and once again comparison needed to be done in order to identify any differences. 6. All the pulse rates are needed to count twice as to get the average result. In other words, the palpation processes need to be repeated.

(c)Arterial Blood Pressure

I. Palpation method 1. The subject is asked to rest in sitting position for at least 5 minute. 2. Arm of the subject and the sphygmomanometer are being placed in the same level as the heart of the subject. (Hand of the subject and the sphygmomanometer can place on the table as can maintain theirs level with the level of the hearts easily and can prevent the subject from too tiring maintaining their hands level.) 3. The sphygmomanometer is firmly wrapped around the upper forearm such that the cuff (lower part) must be at least 2.5sm above the cubital fossa. 4. Then the radial pulse of the subject is located. The pressure of the cuff is slowly increases until the radial pulse is no longer palpable. After that, the pressure of the cuff is further increased by another 20mmHg. 5. The pressure of the cuff is immediately but slowly and gradually release. The pressure is released until the radial pulse can be palpate again. 6. The pressure value is determined immediately from the manometer column (mercury level) once the radial pulse are palpable. The result is being recorded into the result sheet. 7. This pressure is known as the subjects SBP (Systolic Blood Pressure). 8. The procedure is repeated as to obtain an average value of the subjects SBP. But the process should be repeat after letting subject resting for several minutes. Auscultation method 1. The subject is asked to rest in sitting position for at least 5 minute. 2. Arm of the subject and the sphygmomanometer are being placed in the same level as the heart of the subject. (Hand of the subject and the sphygmomanometer can place on the table as can maintain theirs level with the level of the hearts easily and can prevent the subject from too tiring maintaining their hands level.) The mercury meniscus should be ensured at readable eye level. 3. The sphygmomanometer is firmly wrapped around the upper forearm such that the cuff (lower part) must be at least 2.5sm above the cubital fossa. 4. Then the radial pulse of the subject is located. The pressure of the cuff is slowly increases until the radial pulse is no longer palpable. After that, the pressure of the cuff is further increased by another 20mmHg.

II.

5. The diaphragm of the stethoscope is gently placed on the cubital fossa over brachial artery. 6. The pressure of the cuff is immediately but slowly and gradually release until tapping sound is heard. The value of the manometer column at this point is considered as the subjects SBP. 7. The pressure of the cuff is slowly released again and the differences in the pitch and the loudness of the sounds heard. The sound that is heard as the pressure of the cuff is reduced is known as Korotkoff sounds. 8. When the Korotkoff sound become muffled and eventually inaudible, the pressure value of the manometer at that point is considered as the subjects DBP (Diastolic Blood Pressure). The result is being recorded to the result sheet. 9. The procedure is being repeated after a gap of several minutes as to obtain the average values of the subjects SBP and DBP.

Result
(a) Heart Sounds Areas of auscultation (valve) Aortic valve Pulmonary Valve Triscuspid valve Mitral valve (b) Arterial Pulses Rest* Subject 1 2 1 72 68 2 74 70 Avg 73 69 1 77 74 Sit/Stand* 2 77 72 Avg 77 73 1 104 90 Exercise* 2 94 90 Avg 99 90 S1 Softer Softer Softer Softer S2 Louder Louder Louder Louder Splitting No splitting S2 splitting S1 split S1 split S3 & S4 Not heard Not heard Not heard Not heard

*Pulse per minutes (c) Blood Pressure Palpation SBP(mmHg) Subject 1 2 1 110 92 2 110 94 Avg 110 93 1 110 92 SBP(mmHg) 2 110 92 Avg 110 92 1 80 72 Auscultation DBP(mmHg) 2 80 76 Avg 80 74

Discussion
1. Explanation (a) Comparison of the result obtained from a single subject i. At part (a), the results obtained might not be the accurate answer as there are many uncontrollable errors. This includes the listening ability of each person is different and the ability to interpret the sound heard are differs.

At part (b), subjects pulse rate is gradually increased after doing some exercise. This is because after subjects do the exercise, the rate of respiration will increase as the subjects need to slowly restable his/her breaths rate. Before he/she manage to do so, their hearts will pump faster as it will increase the respiration rate and thus increase the volume of oxygen inhaled. As a result, pulse rate will increase too. iii. At part (c) both the subjects blood pressure are in the normal range. Blood pressure of a normal person is 120/80mmhg. (b) Comparison with other group members i. At part (b) and (c), the subject 2s pulse rate and blood pressure are lower than subject 1. This may be because of subject 2 is a person whom always do exercise. ii. Athletes and those who exercise regurlary tend to have lower blood pressure and slower heart rate. (c) The vibrations in the blood and the tissues when the valves close will cause heart to beats and thus producing the heart sound. By using a stethoscope, the heart sound can be listens clearly if and only if the diaphragm of the stethoscope is placed at the right auscultation position. Through the auscultation, we can determine the condition of the heart roughly. (d) There are two heart sounds which is S1 and S2 for a normal person. The S1 is the sound produced when the atrioventricular valve is closed. While the S2 is the sound produced when semilunar valves is close. Thus, there will be two sounds produced periodically each time the heart beats which sound like lubb-dupp. (e) After doing some simple exercises, the heart sound of a subject is louder and faster. This is because the subject needed more oxygen and thus increasing his/her respiration rate. As the rate of the respiration increase, the demand of the oxygen needed by the subject will be replenish. After a while, the rate of respiration will slowly reduce to the normal level. (f) Pulse rate of a normal person is around 60-100 beats per minute. Anyone with heartbeat which is more or less than the range should immediately refer to the doctor. (g) In this experiment, there are no S3 and S4 is heard. Therefore, we can conclude that the 2 subject are considered healthy. (h) Normal blood pressure of a person is around 120/80mmHg. Since both of the subject having the values around the normal range. Thus, there are considered to be healthy. (i) If person with high blood pressure they are known as hypertension while person with low blood pressure will be known as hypotension. Hypertension will put the person to risk for heart failure, strokes, heart attacks, arterial aneurysm and also chronic renal failure. For person with hypotension, they will have risk of facing dizzy or undergo faint or seizures. They also have a risk of organ failure as there is not enough blood transfer to all organs. 2. Errors I. The comparison of S1 and S2 in part (a) might be a bit differences from the

ii.

actual fact. This is because the difference between S1 and S2 is determined through personally determination ability. Different people have different ability to determine the differences thus there will be mistake during the experiment. Besides that, during the auscultation process, we might exactly place the diaphragm at the right position as shown in the figure below.

A- Aortic valve B- Pulmonary Valve C- Triscuspid Valve D- Mitral Valve II. In part (b) where pulse rate of the subject need to be counted. Errors might occur as counting pulse rate without a device is not as accurate as the result we obtain from digital blood pressure machine. 3. Precautions I. The level of the eyes must be perpendicular to the meniscus level of the mercury when taking the readings as to eliminate parallax error. II. The cuff of the sphygmomanometer must be wrapped at least 2.5cm above the cubital fossa. This is to make sure that the results obtain is more accurate. III. During the moment where the pressure of the cuff is increased, the pressure must be increased slowly and gentlely as to prevent applying too much pressure onto the forearm of the subject as this will injured the forearm of the subject. IV. The procedure should be repeated after letting the subject to rest for at least 5 minutes to prevent the subject from exhausted and can obtain a more accurate result. V. When handling the mercury sphygmomanometer, we should be becareful as mercury is a highly toxic and corrosive element.

Conclusion
From the result, we can conclude that the two subjects are healthy as their heart sounds, pulse rate and blood pressure are around the normal range. Although their readings are slightly lower than the normal range, but still consider as healthy.

References
1. Edith Applegate, The Anatomy and Physiology Learning System. 3rd Edition. Saunders Elsevier. Canada. Page233-249. 2006. 2. Walker, H.K., Hall, W.D., Hurst, J.W., Clinical Methods: The History, Physical and Laboratory Examinations. 3rd Edition. Butterworth-Heinemann Ltd. 1990.